HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Kaan Kirali Tuncer Koçak Füsun Güzelmeriç Deniz Göksedef Nihan Kayalar Cevat Yakut Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kirali, K. Articles by Yakut, C. Search for Related Content PubMed PubMed Citation Articles by Kirali, K. Articles by Yakut, C. Related Collections Coronary disease

Ann Thorac Surg 2004;78:1598-1602
© 2004 The Society of Thoracic Surgeons

---

Original article: cardiovascular

Off-Pump Awake Coronary Revascularization Using Bilateral Internal Thoracic Arteries

^a Department of Cardiovascular Surgery, Kouyolu Heart and Research Hospital, Istanbul, Turkey
^b Department of Cardiovascular Anesthesia, Kouyolu Heart and Research Hospital, Istanbul, Turkey

Accepted for publication May 17, 2004.

^* Address reprint requests to Dr Kirali, Department of Thoracic and Cardiovascular Surgery, Kouyolu Heart and Research Hospital, 81020 Kadköy, Istanbul, Turkey
imkkirali{at}yahoo.com

BACKGROUND: A new technique has been developed that permits complete arterial revascularization of the lateral and/or inferior wall of the heart using in situ bilateral internal thoracic artery grafts in awake patients. This technique, without cardiopulmonary bypass and mechanical ventilation, creates the least invasive revascularization method for the lateral and/or posterior wall of the heart yet described.

METHODS: In 7 patients double or triple vessel coronary artery bypass grafting was performed without general anesthesia. A high thoracic epidural anesthesia was started one hour before surgery. Bilateral internal thoracic arteries were harvested and all anastomoses were performed with the off-pump technique by standard median sternotomy. Circumflex, or the right coronary artery, were anastomosed with bilateral internal thoracic arteries using a heart positioner. Six patients received double bypass grafting and one patient received triple bypass grafts (bilateral internal thoracic arteries and one radial artery).

RESULTS: All patients remained awake throughout the whole procedure. There was no perioperative myocardial infarction or mortality. Pneumothorax was observed in three patients, but it was repaired in two. Only one patient completed the procedure with unilateral pneumothorax. There were no hemodynamic and pulmonary problems during lateral or posterior wall revascularization. Two patients required unexpected coronary endarterectomy during circumflex and right coronary artery anastomoses.

CONCLUSIONS: Complete arterial revascularization by median sternotomy using in situ bilateral internal thoracic artery grafts without general anesthesia is a feasible and safe procedure for multivessel disease. This approach gives a chance for awake revascularization of the right and/or circumflex coronary artery.

This article has been cited by other articles:

				N. Noiseux, I. Prieto, D. Bracco, F. Basile, and T. Hemmerling Coronary artery bypass grafting in the awake patient combining high thoracic epidural and femoral nerve block: first series of 15 patients Br. J. Anaesth., February 1, 2008; 100(2): 184 - 189. [Abstract] [Full Text] [PDF]

				K. Kirali, N. Kayalar, T. Kocak, and C. Yakut Reversed-J inferior sternotomy for awake coronary bypass Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 923 - 924. [Abstract] [Full Text] [PDF]